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Two GPs suspended for ‘inappropriately’ prescribing opioids online

Two GPs have been suspended from the GMC register for prescribing opioids online to multiple patients through an online pharmacy without appropriate safeguards in place.

Following a decision by the Medical Practitioners Tribunal Service (MPTS), Dr Dharson Dharmasena and Dr Edward Pooley were suspended for six and three months respectively after inappropriately prescribing opioids to patients, including those with histories of drug addiction.

There have been growing concerns over online prescribing providers handing out opioids to patients without informing their GPs or consulting their medical records.

In May 2017, the CQC referred Dr Dharmasena and Dr Pooley to the GMC regarding their treatment of a number of patients.

The GMC also received complaint letters from GPs whose patients had been prescribed opioids by Dr Dharmasena and Dr Pooley at private online companies White Pharmacy and The Online Clinic, based in the Waverley area.

The regulator accused Dr Dharmasena of failing to obtain an ‘adequate medical history’ from patients’ GP records while working at White Pharmacy.

After reviewing the evidence, the MPTS found Dr Dharmasena had referred to a patient questionnaire, filled in when patients place their orders for opioid medication.

The tribunal said Dr Dharmasena did not assess patients properly and in some cases issued ‘a number of online prescriptions of opioid medication’ when the drugs had ‘habit forming potential’.

Dr Dharmasena inappropriately prescribed opioids such as dihydrocodeine, codeine, solpadol, and gabapentin on 14 different occasions, concluded the tribunal.

In his witness statement, Dr Dharmasena said he ‘felt that the patient questionnaires were able to capture adequate information’ and the questions were similar to what he would ask in a face-to-face consultation for him to prescribe opioid medication.

Evidence presented during the hearing included the example of one patient, identified as patient K, who was prescribed dihydrocodeine, which can cause respiratory problems and possibly even death. Their GPs’ complaint letter stated patient K has a history of depression and an addiction to prescription medication.

Dr Dharmasena also added that at the time he believed his actions were appropriate and adequate, but that he can now see why it was not. In a further statement, he continued to apologise for his actions and omissions and clarified that his intentions were ‘never to encourage medication misuse or abuse, nor to circumvent the hard work and effort of the respective GPs’.

The tribunal said: ‘Dr Dharmasena can now see that his actions were wrong but he has not yet accepted that he should have known at the time that they were wrong’.

It decided there was a risk Dr Dharmasena would repeat his actions and that he should be suspended from practice with immediate effect, for six months.

Dr Pooley was also practising at White Pharmacy on an ad-hoc basis between 2015 and 2017, and for another online service, The Online Clinic.

The tribunal found Dr Pooley had inappropriately prescribed opioid medication over a 15-month period to 19 patients.

Dr Pooley was accused, along with others, of prescribing one patient, named patient P, over 20 prescriptions of dihydrocodeine before their GP was informed.

In his submission to the tribunal, Dr Pooley provided a reflective statement saying he accepted and regretted his mistakes, which ‘placed patients at risk of developing or exacerbating opioid dependency’.

The tribunal decided Dr Pooley had shown insight, that there was no significant risk of repeating the behaviour and it was not in the public interest to remove a competent GP from practice for ‘any longer than necessary’.

The GP’s lawyer stated Dr Pooley no longer undertakes online prescribing and therefore there was no continuing risk to the public.

Dr Pooley will be suspended from the GMC register for three months – including a ban on issuing private prescriptions during the period – following a 28-day window for appeal, starting from 18 July.

The CQC has previously reported that online prescribing providers are ‘unsafe’, finding 43% prescribe high volumes of antibiotics, inhalers, and opioids without consulting patients’ own GPs.

The health secretary announced earlier in April that all opioid medicines in the UK will now carry addiction warnings on the labels, and a national review of addictive prescription drugs is due later this summer.